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Update to Valvular Heart Disease Guidelines 2017

CardioSmart News
The American College of Cardiology and American Heart Association have released an update to guidelines for the management of patients with heart valve disease. Written by a team of health experts, these guidelines address a few changes to the diagnosis and treatment of heart valve disease since the release of guidelines in 2014.

Heart valve disease includes a range of conditions that occur when any of the heart’s valves don’t work properly. Heart valve disease happens when the heart’s valves can’t open far enough to let blood through (stenosis) or can’t close enough to prevent blood from flowing back into the heart (regurgitation).

As with many other conditions, the management of heart valve disease is ever-evolving thanks to continual research. Since 2014, a number of clinical trials have helped inform updates to recommendations for treatment. This is what every patient should know about the latest recommendations for the management of heart valve disease:

  • One of the biggest updates to guidelines concerns the use of transcatheter aortic valve replacement, often referred to as TAVR. TAVR is a minimally invasive procedure that repairs faulty heart valves. It has become more widespread in the past decade. Based on the latest research, authors conclude there’s stronger evidence to consider TAVR in certain patients. For example, there’s strong evidence that TAVR is a reasonable option instead of surgery for high-risk patients with severe aortic stenosis. Authors also note there’s moderate evidence supporting TAVR instead of surgery for similar patients with intermediate surgical risks.

  • A second update regards the use of blood thinners in patients with valve disease and atrial fibrillation. Depending on patients’ cardiovascular risk and their specific type of valve disease, experts highlight the importance of blood thinners to reduce risk of complications. For example, blood thinners plus a vitamin K antagonist are recommended for patients with atrial fibrillation and rheumatic mitral stenosis. Blood thinners also should be used in patients at greater risk of stroke with AFib and either native aortic valve disease, tricuspid valve disease or mitral regurgitation.

  • Further updates involve the use of valve replacement and treatment for mitral regurgitation. Experts expanded the age range for aortic or mitral valve replacement from ages 60-70 to 50-70. Experts also noted that mitral valve surgery is reasonable for certain patients with severe primary mitral regurgitation.

Throughout the guidelines, authors also note the importance of shared decision-making between patients and their providers. Depending on the type and severity of valve disease, there may be a number of potential treatment options, ranging from lifestyle changes to medication or surgery. Therefore, it’s important for patients to understand the risks and benefits associated with these options and work with their providers to make the best possible treatment decisions.

For more information about heart valve disease, go to CardioSmart.org/HeartValveDisease.

Read the full update to these guidelines in the Journal of the American College of Cardiology: "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease."

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